1. INCOPORATING NCI INTO A QUALITY REVIEW SYSTEM CONNECTICUT DMR Laura Nuss, Director of Strategic Leadership Reinventing Quality Conference 2004

2. BACKGROUND AND DESIRED OUTCOMES Design a new quality review system to incorporate the achievement of personal outcomes and measures of consumer satisfaction Apply the system to assess all providers of service Integrate existing quality activities into the new system Use valid and reliable measures NO DUPLICATION of effort

3. Previous Activities State licensing of group homes and family living homes Regional oversight of group homes and day programs Case Management oversight of the individual plan NCI Consumer Interviews and other surveys Overall reliance on documentation and physical plant reviews

4. National Core Indicators Difficulty conducting enough interviews each year, declining work force Yet, the survey is a valid measure that addresses personal outcomes and satisfaction measures Integrate the two processes, new quality review and the NCI project

5. QUALITY SYSTEM ELEMENTS Focus Areas Personal Outcomes within each Focus Area Indicators from the perspective of the person and the support system that suggest the achievement of the outcome Quality data elements/measures that answer if the Indicators are achieved

6. QUALITY SYSTEM FOCUS AREAS AND PERSONAL OUTCOMES Planning and Personal Achievement People direct their own planning process People realize their goals for the future People develop and use personal competencies Relationships and Community Connections People have satisfying and meaningful relationships People participate in community life

7. QUALITY SYSTEM FOCUS AREAS AND PERSONAL OUTCOMES Choice and Control People choose where and with whom they live People choose what they do for work, retirement, or other day options People choose their daily routines and make changes as desired People choose their own personal support providers Rights, Respect, and Dignity People are valued and respected People are free from abuse and neglect People exercise their rights People have economic security

8. QUALITY SYSTEM FOCUS AREAS AND PERSONAL OUTCOMES Safety People are protected from fire and other life threatening situations People live and work in safe, clean, and personalized environments Health and Wellness People experience the best possible health People receive needed medical and health care

9. FOCUS AREAS Planning and Personal Achievement  Relationships & Community Connections  Choice & Control  Rights, Respect, & Dignity  Safety  Health & Wellness QUALITY DATA SOURCES Observation Record Review Individual Interview (NCI) Support Staff Interview Safety Checklist Regional and system data INDICATORS a)Individual Guidelines b)Support Guidelines INFORMINFORM INFORMINFORM PERSONAL OUTCOMES 1 2 3 4 5 6. 17 INFORMINFORM QUALITY REVIEW Expectations Review Evaluation Results

10. QSR Example Focus Area: Planning and Personal Achievement Outcome: individual directs his/her planning process Individual Indicator: the individual identifies his or her goals for the future to support their chosen lifestyle: Measures: CI: at the planning meeting, did people ask you wanted to do in the future? CI: does your case manager ask you what you want? D: the plan indicates the individual directed the process D: individual preferences are identified in the plan Support Indicator: the individual is supported to participate in his/her planning process: Measures: SI: how do you help the individual prepare for and participate in the planning process? D: the plan identifies the supports needed to achieve goals based on current functional assessments

11. I.AThe Individual Directs His or Her Planning Process Individual 1.I.A.a.1Goal Identification The individual identifies his or her goals for the future. N8-helpsgetConsumer InterviewIf you ask for something, does your case manager help you get what you need? N9-askimporConsumer InterviewDoes your case manager ask you what you want? CI2Consumer InterviewAt your planning meeting, did people ask you what you wanted to do in the future? D1DocumentationThe individual's plan indicates he or she directed the planning process. Individual 2.I.A.a.2Plan Development The individual develops plans to reach his or her goals. N10-servedConsumer InterviewDo you get the services you need? D1DocumentationThe individual's plan indicates he or she directed the planning process. Individual 3.I.A.a.3Plan Review and Change The individual reviews, changes, and approves his or her plan on an ongoing basis. D2DocumentationThe individual's plan is developed timely based on his or her personal circumstances or goals. Support 4.I.A.b.1Planning Process Support The individual is supported to participate in his or her planning process. SPI1Support Person InterviewHow do you help the individual prepare for and participate in his or her planning process? Support 5.I.A.b.2Plan Development Support The individual's preferences, strengths, assessments and goals are the basis of his or her plan. D3DocumentationThe individual's preferences are identified in his or her plan. D4DocumentationThe individual's plan identifies supports he or she needs based on current functional assessments.

12. Support 6.I.A.b.3Plan Review And Revision Support The individual's plan is reviewed and revised based on changes in his or her personal circumstances and goals. D2DocumentationThe individual's plan is developed timely based on his or her personal circumstances or goals. D10DocumentationThe individual's plan is updated timely based on changes in his or her personal circumstances and decisions. SPI2Support Person InterviewWhat are the specific strategies in place to help the individual achieve his or her goals? SPI3Support Person InterviewIs the individual's support plan developed, reviewed and updated based on changes in his or her life circumstances and dreams for the future? Support 7.I.A.b.4Provider Performance Feedback The individual's support and service are influenced by his or her feedback about provider performance. N45-likehomeConsumer InterviewDo you like your home or where you live? N4-helpgoalConsumer InterviewDo people help you do new things you want to do? N10-servedConsumer InterviewDo you get the services you need? CI62Consumer InterviewAre you satisfied with progress toward your goals for the future? CI35Consumer InterviewAre you satisfied with your financial situations? D21DocumentationThe individual's record documents his or her input concerning the evaluation of personal services and the systems that support those services.

13. IV.CThe Individual Exercises His or Her Rights Individual 63.IV.C.a.1Exercise Rights The individual exercises his or her basic liberties as he or she chooses. N18-bealoneConsumer InterviewCan you be alone if you want to? N20-enterhmConsumer InterviewDo people including staff let you know before they come into your home? N21-enterbrmConsumer InterviewDo people including staff ask permission before coming into your bedroom? N27-seefrndsConsumer InterviewCan you see your friends when you want to see them? N30-seefamlyConsumer Interview Can you see your family when you want to? N36-choosbuyConsumer InterviewDo you get to choose what you buy with your spending money? N29-alonegstConsumer InterviewCan you be alone with friends or does someone have to be with you? N17-usephonConsumer InterviewAre you allowed to use the phone when you want to? CI14Consumer InterviewHas anyone spoken to you recently about your rights as a citizen and as a support consumer? Individual 64.IV.C.a.2Complaint Expression The individual expresses his or her concerns and grievances. CI13Consumer InterviewIf you have a problem, do you have someone to talk to? Individual 65.IV.C.a.3Personal Information Disclosure The individual or his or her guardian control access to personal information. D12DocumentationThe individual's record contains all necessary consent forms. Individual 67.IV.C.a.5Self-Advocacy - Participation The individual participates in self-advocacy groups or activities as desired. N42-clubsConsumer InterviewDo you go to clubs or other community meetings? N22-selfadvoConsumer InterviewHave you ever participated in a self-advocacy group meeting, conference or event?

14. INTEGRATING ACTIVITIES Case Managers and Case Management Supervisors use selected quality measures when assessing plan development, participation and implementation Regional Quality activities incorporate selected quality measures to assess planning, rights, satisfaction, safety and health State review of a sample of individuals in all service/support types using all quality measures

16. Implementation Draw state sample for consumer interview participation in NCI Regional Quality Review staff cross reference individuals with locations and individuals they will be reviewing during the course of the year State Quality Review staff cross reference individuals to provider and regional reviews scheduled Quality Review staff conduct the NCI consumer interview during a quality review visit Any individuals in the sample not addressed by the quality reviews are interviewed independently for the state submission to NCI project

17. Numbers and Uses State sample for CT is 400-450 Quality Review will capture 1,000 or more Increases data pool for CT to assess its own performance NCI data results sent to HSRI NCI data results integrated within the quality review tool to inform personal outcomes